HomeHealthAre you planning a surgery? You may not need all of...

Are you planning a surgery? You may not need all of those tests beforehand.

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Sometimes a preoperative test of questionable value results in unforeseen complications, as happened to a man in his 50s scheduled for a very painful hernia repair. Two Colorado Doctors reported in 2014 that laboratory tests and physical examination of the man were normal. But a chest X-ray, ordered because he had a history of mild asthma, suggested he had a nodule in one lung.

Doctors delayed surgery until they did a CT scan, which did not confirm a lung nodule, but did find one in an adrenal gland. Once again, the doctors postponed the surgery to allow further evaluation of the adrenal nodule, which ultimately turned out to be benign. The man finally had his hernia repaired after an additional six months of debilitating pain and repeated anxiety over incidental test results that suggested he might have cancer.

However, doctors are making progress. On 2019 in JAMA Internal Medicine, Dr. John N. Mafi, an internist at the David Geffen School of Medicine at the University of California, Los Angeles, and their colleagues described an effort to reduce “low-value preoperative care” for patients about to undergo surgery. cataract surgery. New guidelines were issued and a quality improvement nurse advised surgeons on the new recommended protocol. The result, evaluated in a controlled clinical trial of 1,054 patients, was a dramatic decrease in preoperative testing, significant projected cost savings after the first year, and “no measurable adverse effects” in patients’ surgery, he said.

Perhaps the most troublesome among common preoperative procedures is a cardiac stress test, which assesses blood flow to the heart while patients exercise. Dr. Alana E. Sigmund, an internal medicine physician at the Hospital for Special Surgery in New York who has studied physician responses to preoperative guidelines, said in an interview: “Cardiac stress tests are over-requested. If there is no evidence of a heart problem, such as shortness of breath, there is no reason to do this test before surgery. “

The latest guidelines, which the American College of Cardiology and the American Heart Association issued in 2014, cautions that, in general, a cardiac stress test is not recommended before surgery for patients who do not have symptoms that suggest heart disease. The guidelines leave the decision to perform the test in the hands of the doctor, and you might think that it is best to rule out a possible heart problem before surgery. But the existing evidence shows no health or life-saving benefits from a preoperative stress test when the patient lacks heart symptoms or has fewer than two major risk factors for having a heart attack, such as high blood pressure and smoking. especially when the prospective surgery itself is low. risk.

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